Perioperative Chemo With FLOT Ups Survival in Resectable Esophageal Cancer

THURSDAY, Jan. 23, 2025 (HealthDay News) — For patients with resectable esophageal adenocarcinoma, perioperative chemotherapy with fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) leads to improved survival compared with preoperative chemoradiotherapy, according to a study published in the Jan. 23 issue of the New England Journal of Medicine.

Jens Hoeppner, M.D., from Bielefeld University in Detmold, Germany, and colleagues conducted a phase 3 multicenter trial involving patients with resectable esophageal adenocarcinoma who were randomly assigned to receive perioperative chemotherapy with FLOT plus surgery or preoperative chemoradiotherapy (radiotherapy at a dose of 41.4 Gy and carboplatin and paclitaxel) plus surgery (221 and 217 patients, respectively). Eligibility criteria included a primary tumor with clinical stage cT1 cN+, cT2-4a cN+, or cT2-4a cN0 disease. The primary end point was overall survival.

The researchers found that overall survival at three years was 57.4 and 50.7 percent in the FLOT and preoperative-chemoradiotherapy groups, respectively, with a median follow-up of 55 months (hazard ratio for death, 0.70). At three years, progression-free survival was 51.6 and 35.0 percent in the FLOT and preoperative-chemoradiotherapy groups, respectively (hazard ratio for disease progression or death, 0.66). Among the patients who started the assigned treatment, grade 3 or higher adverse events occurred in 58.0 and 50.0 percent of those in the FLOT and preoperative-chemoradiotherapy groups, respectively.

“The current trial showed superior overall survival with FLOT as compared with preoperative chemoradiotherapy, with a median overall survival of 66 and 37 months, respectively,” the authors write.

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